2699 /L•,��/��I A//xW ZAP iI/P/!/L LOT NO. SO
® NoCa�f4�?EIC'A ION FOR PLUMBING PERMIT
u, a CITY OF CUPERTINO
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Sanitary 1u.
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3 a Date �PR/� /O , 196 Permit No 6 99 _
w� CITY OF CUPER t. , Fees isoa
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0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> ) and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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4 Use of Premises RES//JE/!/CE
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3 Owner J� C F �LUO% Address/y09l /I/, C!J/A/CNFS%� r
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Z By�/O6��/7 AP//� �%,Vb/�T/9GAddress �� [yOy /SO c 9Aly7xtfe,4P/�
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CONTRACTOR, AGENT
— 0 Phone
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01 State License Approved
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PLUMBING INSPECTOR
EMP
FIXTURES \ E MAIN DRAIN
t UNITS FEES UNITS FEES
Water Heater Size
Water Closets qq MatCc3! �.
Bath Tubs O To Curb
Showers / (?,o To Prof. Line
Lavatories 3 To Existing
Kitchen Sinks /, Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines j /LZ Size
-%Xl*ater Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dehtal Units
Drinking Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material yo
San Traps TOTAL FEES
Urinals Fixture Fee 0, 00
Arca Drains Main Drain Fee ,pp
Water Leaders Storm Drain Fee
9prinklcr Valves Water Sys. Fee �� 6?-0
Permit Fee 11�, (ya
TOTAL 0 /0 all TOTAL FEE — Q
RECORD OF INSPECTION
Underground Rough. .
.Partial Rough-
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Rough Complete.. ��— /
.Iain Drain i — t
Final... � /